Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 19957 | FL |
Y | 1223P0221X | Pediatric Dentist | 19957 | FL |
NPI | 1053547703 |
---|---|
Provider Name | Dr. Mabel Coro |
First Address | Homestead, FL 33033-7613 |
Second Address | Homestead, FL 33033-7613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2009 |
Last Update Date | 05/11/2012 |